title: Invasive assessment of renal artery atherosclerotic disease and resistant hypertension before renal sympathetic denervation.
abstract: BACKGROUND
  Renal sympathetic denervation (RSD) is emerging as a new therapeutic option for patients with severe hypertension refractory to medical therapy. The presence of a renal artery stenosis may be both a cause of secondary hypertension and a contraindication to RSD if a renal artery stent is implanted; therefore, the definition of the functional importance of a renal artery stenosis in a patient with refractory hypertension is crucial.
  
  
  METHODS
  We describe the imaging and functional intravascular assessment of an angiographically severe stenosis of the renal artery in a patient with severe refractory hypertension, by means of intravascular ultrasound (IVUS), and measurement of the translesional pressure gradient with a pressure wire.
  
  
  RESULTS
  Pressure wire examination excluded any severity of the stenosis, and IVUS showed the presence of a dissected plaque that resolved spontaneously after 3 months of intensive medical therapy and high-dose statin. Subsequently the patient was treated with RSD, achieving a significant effect on blood pressure control.
  
  
  CONCLUSIONS
  Intravascular imaging and functional assessment of renal artery anatomy in patients with atherosclerotic disease may prove particularly suited to patients with refractory hypertension and multilevel vascular disease who are considered for endovascular therapies, either renal artery stenting or RSD.
authors.affiliation: Department of Medicine, University of Verona, Verona, Italy. flavio.ribichini@univr.it
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.forename: Michele
authors.initials: M
authors.lastname: Pighi
authors.forename: Carlo
authors.initials: C
authors.lastname: Zivelonghi
authors.forename: Alessia
authors.initials: A
authors.lastname: Gambaro
authors.forename: Enrico
authors.initials: E
authors.lastname: Valvo
authors.forename: Antonio
authors.initials: A
authors.lastname: Lupo
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D006978:Hypertension, Renovascular / Q000150:complications* / Q000601:surgery*; D007668:Kidney / Q000294:innervation*; D008297:Male; D011300:Preoperative Care; D012078:Renal Artery Obstruction / Q000150:complications* / Q000000981:diagnostic imaging*; D013562:Sympathectomy; D018084:Ultrasonography, Interventional